The economic crisis in Greece has dominated headlines in Europe for the past few years. The country recently secured a bailout worth €130 billion, but no one believes this will solve the crisis given that previous bail out loans of €110 billion in May 2010 and €109 billion in July 2011 proved insufficient. Greece's public sector has been hit hard by the ongoing austerity measures imposed on it and even now the government is spending more than it can receive through taxes. This perilous state of affairs is having a wide range of negative impacts on society. Unemployment and homelessness is rising, as is crime, and there have also been outbreaks of violence on the streets.

Healthcare in disarray

Nathan Jessop

The economic crisis has devastated the Greek healthcare system, with austerity measures introduced by the government resulting in significant budget cuts for hospitals. The Greek healthcare system was already suffering from understaffing and under resourcing before the crisis. Now, treatment waiting times have increased further and many people are turning to street clinics that had originally been set up by non-governmental organisations for those outside the mainstream system. Médecins du Monde has estimated that the proportion of Greeks now seeking medical attention at such street clinics is around 30%. Before the crisis, it was only 3–4% (1). There have also been warnings of a rise in infectious diseases such as tuberculosis, malaria, hepatitis and HIV (2). These findings are a shocking development considering that the Greek healthcare system was highly ranked by the World Health Organization in 2000 (3).

Another sign of decline in the country's healthcare system is the disruption of the pharma supply chain. The government cutbacks have resulted in shortages of many medicines around the country. In January, the Panhellenic Association of Pharmacists described 500 commonly used drugs as being in short supply, including painkillers and products for hypertension, gastroenterological disorders, kidney disease and cancer (4). A commonly cited point in the media was that some pharmacies had even run out of aspirin (5).

Previously, strikes by pharmacists had accounted for drug shortages, but the current supply problems are more complicated. In 2011, the Greek government enforced heavy price cuts for pharmaceuticals. According to the new law, a drug's price is set according to the average of the three lowest priced countries in the EU. As a result, Greece's spending on pharmaceuticals only amounted to €4.1 billion in 2011 compared with €5-6 billion in 2010 (6). The national spending on pharmaceuticals for 2012 has been predicted to be around €2.8 billion. Recently, Greece's health minister, Andreas Loverdos was quoted as saying that excessive spending on unnecessary drugs amounted to a value of €1 billion per year (6).

The government-enforced price cuts mean that wholesalers prefer to sell their stocks in other countries where they can make higher profits. The problem has also been exacerbated by public insurers delaying payments to pharmacies, which have then been unable to pay their suppliers. The lack of funding has been detrimental for the pharmacy sector. Out of the 12000 pharmacies that operate, 800 are facing closure and a further 200 have severe operational difficulties (4).

Rather than keep their stock lying around in warehouses or waiting for payment from pharmacies, wholesalers are maintaining their business by re-exportation. In 2011, the amount that public insurers owed pharmacists exceeded €400 million (5). As payments can take three months, pharmacists recently announced that they could only supply medicines to patients who paid with cash. For many patients, this is impossible due to their financial circumstances.

Media reports suggest that Greece has become a pan-European source for parallel trade products. Prior to the economic crisis, parallel trade was described as having plateaued in Greece because pharmaceutical companies had imposed supply quotas for the country. However, pharmacies in other countries often turn to Greece to replenish their supplies when they are low on stocks. In effect, the financial incentive to supply a drug outside Greece rather than for domestic customers is creating new clients across Europe. This situation has also led to cases of fraud where a bill is still submitted for reimbursement to public insurers as if the drug had been prescribed to a patient locally. Reimbursement fraud has been estimated by the European Federation of Pharmaceutical Industries and Associations (EFPIA) to cost Greece more than €500 million, which places further strain on the healthcare system (5).